Holistic Care Plan
Hypertension is a pathology of the cardiovascular system that develops due to dysfunction of higher centers of vascular regulation and neurohumoral and renal mechanisms. It leads to functional and organic changes in the heart, CNS, and kidneys. Subjective manifestations of high blood pressure are headaches, tinnitus, palpitations, shortness of breath, pain in the heart, and numerous other possible symptoms. Blood pressure is subject to fluctuations – depending on the time of day or physical activity, and therefore long-term monitoring is necessary to detect abnormalities. The most dangerous thing about hypertension is that it can slowly and unnoticeably lead to conditions such as stroke, heart attack, or kidney failure.
The selected group includes people with signs of or at risk for hypertension. The choice is made due to a lack of comprehension among the population of the consequences of not treating and controlling the disease promptly. An estimated 1.28 billion adults aged 30-79 years worldwide are hypertensive, most of whom live in low- and middle-income countries (Mills & He, 2020). Yet less than half of adults with hypertension are diagnosed and treated. Furthermore, approximately 46% of adults with hypertension do not suspect they have the disease, and it is one of the most common causes of death (Mills & He, 2020). Reducing the prevalence of hypertension by 33% between 2010 and 2030 is among the global noncommunicable disease goals and a critical Healthy People theme. The choice of this topic was prompted by the need to intervene and stop the spread of the disease, which has become an issue for many people. Control of hypertension and its effective treatment is an integral part of population wellness and a necessary task for every health care provider.
Nursing Diagnoses
Excess body weight and obesity is one of the causes of arterial hypertension. More than 50% of obese patients have been diagnosed with arterial hypertension (Mills & He, 2020). Although the relationship between arterial hypertension and obesity was described in 1923, the most substantial evidence was provided later in the Framing Heart Study. It indicated that developing arterial hypertension is two times higher in the overweight or obese population (Mills & He, 2020). There is a linear affinity between body weight and blood pressure levels. Every 4.5 kg increase in body weight results in a four mmHg increase in systolic blood pressure, and a decrease in body weight results in a reduction of both systolic and diastolic blood pressure.
Lack of cognitive information or psychomotor abilities needed to restore, maintain, or promote health have also been identified. Knowledge has a significant role in a patient’s life and recovery. It can include any of three domains: the cognitive, the affective, and the psychomotor, all of which are underdeveloped. Therefore, it is crucial to focus on patient education to provide nursing care to achieve the best outcomes. The goal of nursing is to make the patient capable of meeting self-care needs, and this process often involves patient education.
The third diagnosis is heart failure or increased risk of heart failure. Uncontrolled hypertension increases it because it causes narrowing, compression, and increased resistance of blood vessels, including those that supply the heart. It leads to poor blood flow to the heart muscle, weakening or damaging the heart. These issues are observed in a sample of patients and make it essential to consider this in the treatment process.
Assessment Data
All patients with elevated BP should have an ECG to diagnose left ventricular hypertrophy (LVH), overload, myocardial ischemia, and arrhythmias. The sensitivity of the method in diagnosing GLV is low. Still, nevertheless, GLV analyzed based on the Sokolov-Layon index (SV1 +RV5-6 >38 mm) or Cornell index (product of QRS amplitude and duration > 2440 mm x ms) is an independent cardiovascular risk factor. It is crucial to evaluate the presence of heart damage and the cardioprotective effect of antihypertensive therapy, at least in patients over 55 years. The objective examination includes measuring height, weight, and waist circumference; an ocular examination to rule out retinopathy; auscultation to rule out neck and abdominal murmurs; complete cardiac, neurologic, and respiratory assessments. Hypertension has a long asymptomatic period in some people, but it is vital to consider any manifestations. It is significant to collect information about patients feelings, headaches, dizziness, pain, shortness of breath, and a sense of fear for subjective assessment. The current and past family and medical history should also be evaluated.
Interview Results
The questionnaire showed that more than 96.3% of those surveyed considered high blood pressure a health risk. Among the risk factors for cardiovascular diseases, the most significant are the following: psycho-emotional tension and stress – 75.1%, bad habits (smoking and alcohol) – 60.2%, improper diet, and excessive weight – 41.2%, sedentary lifestyle – 20.4%. Alarmingly, 29% of respondents do not know their blood pressure readings, and 10.1% do not understand why they need to know. According to the survey, 55.3% of respondents feel their blood pressure is higher than 130/90, but only 20.3% control it regularly, and 35.1% control their blood pressure sporadically.
Among the sources of obtaining information about the prevention of CVDs in the first place, they note that all comprehensive information is received from health workers, the second – from the media, the Internet, and the third – from acquaintances and relatives. The interviews show that men suffer from hypertension more often than women, and the highest prevalence rates are observed in people over 50 years. However, it is worth remembering that hypertension has no age restrictions, and even very young people can suffer from high blood pressure.
Desired Outcomes
The primary task of treating arterial hypertension is to reduce the risk of vascular accidents as much as possible. To achieve this goal, it is necessary to eliminate existing negative factors and stabilize blood pressure within optimal values. The optimal BP for most people with hypertension is less than 140/90 mm Hg (Mills & He, 2020). There is an exception to this rule: for elderly patients, the desired BP is 140-150/90-95 mmHg. It is necessary to keep in mind that it is not recommended to reach too low values of BP (less than 110/70 mm Hg) because hypotension increases the risk of vascular accidents. Hypertension treatment tactics are determined by the degree of BP increase and the risk of cardiovascular complications. Treatment should begin with lifestyle correction in arterial hypertension of the 1st degree and the absence of adverse factors. Only if BP will remain elevated after a few months after the measures are taken – prescribe drug therapy.
The objective of BP treatment is to minimize the risk of AH complications: fatal and non-fatal CVD, CVD, and CPP. To achieve this goal, it is necessary to reduce BP to target levels, correct all modifiable FRs (smoking, dyslipidemia, hyperglycemia, obesity, etc.), to prevent/slow the rate of progression and reduce the severity (regression) of POM, and to treat existing cardiovascular, cerebrovascular and renal diseases. In cases of poor tolerance, BP reduction is recommended in several stages. In the first stage, BP is reduced by 10-15% from baseline over 2-4 weeks, with a possible break for the patient to adapt to lower BP values. Further, the rate of BP reduction is determined individually, and it is necessary to achieve a gradual decrease of BP to the target values.
Evaluation Criteria
Evaluation of hypertension involves accurately measuring the patient’s blood pressure, taking a focused history and physical examination, and obtaining the results of routine laboratory tests. A 12-lead electrocardiogram should be obtained and possible health risks checked. It is important to consider patient criteria and to assess both physical and mental status. To assess immediate results, we will use a methodology based not only on the dynamics of the average hemodynamic blood pressure, but also on changes in the parameters of adrenergic vascular reactivity.
Actions and Interventions
After assessing the total SSR, it is important to determine the individual management tactics for the patient. Its most important aspect is the decision on the advisability of prescribing antihypertensive therapy (AHT). The indication for AHT is determined on the basis of SBP. Persons with high normal BP, in the absence of confirmation of AH by the results of CMAD and/or SCAD, AGT is not indicated, this category of people are recommended non-medicinal prophylaxis and correction of FR. In people with high and very high cumulative CV risk, regardless of the degree of increase in BP, AGT should be prescribed immediately.
For treatment, it is important to use five main classes of AGPs: angiotensin-converting enzyme inhibitors, AT II receptor blockers, calcium antagonists and diuretics, for which the ability to prevent the development of CVC is proven in numerous randomized clinical trials (RCTs) (Mills & He, 2020). All these classes of drugs are suitable for start and maintenance therapy, both as monotherapy and as part of certain combinations. Imidazoline receptor agonists (IRA) α-adreno-blockers (ABA), and direct renin inhibitors (DIRs) can be used as additional classes of AGPs for combination therapy.
Evaluation of Patient Outcomes
To assess the external validity of the findings, it is necessary to determine whether there are features of the disease course or medical technology use that were not considered in the study being analyzed but that may significantly affect the outcomes of the technologies in practice. The main indicators by which clinical outcomes will be evaluated are local and functional efficacy and overall long-term efficacy. It is important to analyze endpoints of pressure and to compare rates to the initial ones to determine the effectiveness of the plan.
Strategies
The role of the family in the rehabilitation process is a serious supportive factor. Providing the patient’s family with the necessary support allows the process to more successful and less draining on the physical and emotional strengths of the patient’s family members. Healthcare organizations should gather information from patients and families to determine the needs of both parties, gaps in care, and opportunities for improvement.
This data can come from focus groups and the strategy will encourage the involvement of friends, family members, and the patient themselves as it will be grounded on their needs. Another strategy is to emphasize the end goal in order to create motivation to become an active participant in the process. It is vital to encourage interest and desire, and to emphasize and teach the role of the family in the care and treatment process. A deeper understanding of the topic and specific goal will help the strategy be implemented quickly and effectively. Furthermore, medical organizations should seek the commitment of staff and physicians. Clinical leaders should create a sense of purpose and ensure that none of the patient engagement strategies are arbitrary.
Reference
Mills, K. T., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223-237. Web.